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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314224
Report Date: 03/18/2026
Date Signed: 03/18/2026 04:15:44 PM

Document Has Been Signed on 03/18/2026 04:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KIM, TAEYONGFACILITY NUMBER:
304314224
ADMINISTRATOR/
DIRECTOR:		KIM, TAEYONGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 383-3190
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
03/18/2026
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Licensee, Taeyong KimTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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An Informal Meeting was conducted on this day in the Orange County Regional Office (OCRO). Present during the meeting were Licensing Program Manager (LPM) Nguyen Tran, Licensing Program Analyst (LPA) Soo Jin Jung, and Licensee Taeyong Kim.

The purpose of this informal meeting was to discuss the following:
• 102416.5 Staffing Ratio and Capacity (01/09/2026)
LPA observed 15 children in care during visit on 01/09/2026.
• 102416.1(a)(12) Personnel Records (01/09/2026)
LPA observed two staff members without criminal record clearance providing care for children on 01/09/2026.
• 1597.622(a)(1) General Provisions and Definitions (02/27/2026)
The personnel file that licensee provided to LPA for Adult 2 (A2) did not indicate A2’s has proof of immunization against influenza, pertussis, and measles.
• 102416.3(a)(6) Alterations to Existing Buildings or Grounds (03/06/2026)
Licensee admitted to using the off-limit area of living room 2 and garage to provide supervision to day care children.

Licensee was provided an opportunity to discuss reasons for deficiencies and detailed plan to be in compliance with California Title 22 Health and Safety Codes (HSC) and Codes of Regulations (CCR).

(Go to Page 2)
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Soo Jin Jung
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KIM, TAEYONG
FACILITY NUMBER: 304314224
VISIT DATE: 03/18/2026
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To ensure the facility will be in compliance with:
• CCR 102416.5 Staffing Ratio and Capacity, Licensee states that when they meet the parents that want to enroll, they will tell them that they have to wait if the facility is at full capacity. Licensee will ensure that additional children will not be enrolled once they have already reached capacity.
• CCR 102416.1(a)(12) Personnel Records, Licensee states they understand the process now, so they will never have a staff member begin working before obtaining criminal record clearance.
• HSC 1597.622(a)(1) General Provisions and Definitions, Licensee states that they understand now, so they will be sure to obtain complete records when hiring staff.
• CCR 102416.3(a)(6) Alterations to Existing Buildings or Grounds, Licensee was reminded not to take children to off-limit areas because inspection in off-limit areas is not completed by the Department. If changes need to be made to off-limit areas, the Department must be notified. Licensee was also reminded that their garage cannot be used the day care.

Licensee, Taeyong Kim was reminded that
• Department’s mission is to protect the health and safety of the children in the community care facilities; it is essential to be transparent in communication and maintain professionalism during LPA’s visits at the facility.
• The licensee will be held accountable to be in compliance with Title 22 HSC & CCR. Should Licensee have any questions, Licensee can consult with Officer on Duty by contacting the OCRO main line at 714-703-2800.
• The licensee was advised to check the Childcare Licensing web site at www.ccld.ca.gov for quarterly updates, training, forms, and regulations.
• Technical Support Program (TSP) information was offered to Licensee. Licensee declined to accept the service.
Exit interview was conducted and report was reviewed with Licensee, Taeyong Kim, who agreed with the above. Appeal Rights were discussed, the facility representative was provided a copy of their appeal rights (LIC 9058). All appeals must be in writing and received by the Regional Office within 15 business days.
LPA Jung provided Korean interpretation throughout the meeting.

(End of Report)
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Soo Jin Jung
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
LIC809 (FAS) - (06/04)
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